Initial Incomplete Thermal Ablation Is Associated With a High Risk of Tumor Progression in Patients With Hepatocellular Carcinoma.

Jie Tan,Tian Tang,Wei Zhao,Zi-Shu Zhang,Yu-Dong Xiao

doi:10.3389/fonc.2021.760173

Abstract

PurposeTo investigate whether incomplete thermal ablation is associated with a high risk of tumor progression in patients with hepatocellular carcinoma (HCC), and to compare the efficacy of repeated thermal ablation and transarterial chemoembolization (TACE) for residual tumor after incomplete ablation.MethodsThis retrospective study included 284 patients with unresectable HCC who underwent thermal ablation from June 2014 to September 2020. The response of the initially attempted ablation was classified into complete (n=236) and incomplete (n=48). The progression-free survival (PFS) and overall survival (OS) were compared between patients with complete and incomplete responses, before and after a one-to-one propensity score-matching (PSM), and between patients in whom repeated ablation or TACE was performed after a first attempt incomplete ablation.ResultsAfter PSM of the 284 patients, 46 pairs of patients were matched. The PFS was significantly higher in the complete response group than in the incomplete response group (P<0.001). No difference in OS was noted between two groups (P=0.181). After a first attempt incomplete ablation, 29 and 19 patients underwent repeated ablation and TACE, respectively. There were no significant differences in PFS (P=0.424) and OS (P=0.178) between patients who underwent repeated ablation and TACE. In multivariate Cox regression analysis, incomplete response (P<0.001) and Child-Pugh class B (P=0.017) were independent risk factors for tumor progression, while higher AFP level (P=0.011) and Child-Pugh class B (P=0.026) were independent risk factors for poor OS.ConclusionAlthough patients with incomplete ablation are associated with tumor progression compared with those with complete ablation, their OS is not affected by incomplete ablation. When patients present with residual tumors, TACE may be an alternative if repeated ablation is infeasible.

Highlights

Hepatocellular carcinoma (HCC) accounts for 90% of primary liver cancer, which is the fourth most common cause of cancerrelated deaths worldwide
The diagnosis of HCC was based on either histological evidence (n=41) or radiological evaluation with reference to the 2018 version of Liver Imaging Reporting and Data System (n=243)
There were no significant differences in progression-free survival (PFS) (P=0.437) and overall survival (OS) (P=0.178) between patients with repeated ablation and transarterial chemoembolization (TACE) after a first attempt incomplete ablation

Summary

Introduction

Hepatocellular carcinoma (HCC) accounts for 90% of primary liver cancer, which is the fourth most common cause of cancerrelated deaths worldwide. Thermal ablation is recommended as a curative therapy for patients with early-stage hepatocellular carcinoma (HCC) who are not candidates for surgical resection and liver transplantation [1,2,3]. Whether incomplete tumor ablation is associated with tumor progression in patients with HCC has not been elucidated in clinical study. The standard therapy for HCC patients with residual tumor after a first attempt incomplete thermal ablation has not yet been established. The present study aims to investigate whether incomplete thermal ablation is associated with tumor progression and to compare the treatment efficacy of repeated thermal ablation and transarterial chemoembolization (TACE) in patients with a residual tumor after a previously attempted thermal ablation

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